Tag: statistics

JMIR Form Res. 2024 May 31;8:e49907. doi: 10.2196/49907.

ABSTRACT

BACKGROUND: The rapid growth of web-based symptom checkers (SCs) is not matched by advances in quality assurance. Currently, there are no widely accepted criteria assessing SCs’ performance. Vignette studies are widely used to evaluate SCs, measuring the accuracy of outcome. Accuracy behaves as a composite metric as it is affected by a number of individual SC- and tester-dependent factors. In contrast to clinical studies, vignette studies have a small number of testers. Hence, measuring accuracy alone in vignette studies may not provide a reliable assessment of performance due to tester variability.

OBJECTIVE: This study aims to investigate the impact of tester variability on the accuracy of outcome of SCs, using clinical vignettes. It further aims to investigate the feasibility of measuring isolated aspects of performance.

METHODS: Healthily’s SC was assessed using 114 vignettes by 3 groups of 3 testers who processed vignettes with different instructions: free interpretation of vignettes (free testers), specified chief complaints (partially free testers), and specified chief complaints with strict instruction for answering additional symptoms (restricted testers). κ statistics were calculated to assess agreement of top outcome condition and recommended triage. Crude and adjusted accuracy was measured against a gold standard. Adjusted accuracy was calculated using only results of consultations identical to the vignette, following a review and selection process. A feasibility study for assessing symptom comprehension of SCs was performed using different variations of 51 chief complaints across 3 SCs.

RESULTS: Intertester agreement of most likely condition and triage was, respectively, 0.49 and 0.51 for the free tester group, 0.66 and 0.66 for the partially free group, and 0.72 and 0.71 for the restricted group. For the restricted group, accuracy ranged from 43.9% to 57% for individual testers, averaging 50.6% (SD 5.35%). Adjusted accuracy was 56.1%. Assessing symptom comprehension was feasible for all 3 SCs. Comprehension scores ranged from 52.9% and 68%.

CONCLUSIONS: We demonstrated that by improving standardization of the vignette testing process, there is a significant improvement in the agreement of outcome between testers. However, significant variability remained due to uncontrollable tester-dependent factors, reflected by varying outcome accuracy. Tester-dependent factors, combined with a small number of testers, limit the reliability and generalizability of outcome accuracy when used as a composite measure in vignette studies. Measuring and reporting different aspects of SC performance in isolation provides a more reliable assessment of SC performance. We developed an adjusted accuracy measure using a review and selection process to assess data algorithm quality. In addition, we demonstrated that symptom comprehension with different input methods can be feasibly compared. Future studies reporting accuracy need to apply vignette testing standardization and isolated metrics.

PMID:38820578 | DOI:10.2196/49907

JMIR Public Health Surveill. 2024 May 31;10:e51734. doi: 10.2196/51734.

ABSTRACT

BACKGROUND: Childhood obesity is a significant public health problem representing the most severe challenge in the world. Antibiotic exposure in early life has been identified as a potential factor that can disrupt the development of the gut microbiome, which may have implications for obesity.

OBJECTIVE: This study aims to evaluate the risk of developing obesity among children exposed to antibiotics early in life.

METHODS: An Italian retrospective pediatric population-based cohort study of children born between 2004 and 2018 was adopted using the Pedianet database. Children were required to be born at term, with normal weight, and without genetic diseases or congenital anomalies. We assessed the timing of the first antibiotic prescription from birth to 6, 12, and 24 months of life and the dose-response relationship via the number of antibiotic prescriptions recorded in the first year of life (none, 1, 2, and ≥3 prescriptions). Obesity was defined as a BMI z score >3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results.

RESULTS: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses.

CONCLUSIONS: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription.

PMID:38820573 | DOI:10.2196/51734

J Cogn Neurosci. 2024 May 30:1-16. doi: 10.1162/jocn_a_02200. Online ahead of print.

ABSTRACT

Neurovascular coupling (NVC) is the tight relationship between changes in cerebral blood flow and neural activation. NVC can be evaluated non-invasively using transcranial Doppler ultrasound (TCD)-measured changes in brain activation (cerebral blood velocity [CBv]) using different cognitive tasks and stimuli. This study used a novel approach to analyzing CBv changes occurring in response to 20 tasks from the Addenbrooke’s Cognitive Examination III in 40 healthy individuals. The novel approach compared various information entropy families (permutation, Tsallis, and Rényi entropy) and statistical complexity measures based on disequilibrium. Using this approach, we found the majority of the attention, visuospatial, and memory tasks from the Addenbrooke’s Cognitive Examination III that showed lower statistical complexity values when compared with the resting state. On the entropy-complexity (HC) plane, a receiver operating characteristic curve was used to distinguish between baseline and cognitive tasks using the area under the curve. Best area under the curve values were 0.91 ± 0.04, p = .001, to distinguish between resting and cognitively active states. Our findings show that brain hemodynamic signals captured with TCD can be used to distinguish between resting state (baseline) and cognitive effort (stimulation paradigms) using entropy and statistical complexity as an alternative method to traditional techniques such as coherent averaging of CBv signals. Further work should directly compare these analysis methods to identify the optimal method for analyzing TCD-measured changes in NVC.

PMID:38820561 | DOI:10.1162/jocn_a_02200

PLoS One. 2024 May 31;19(5):e0303634. doi: 10.1371/journal.pone.0303634. eCollection 2024.

ABSTRACT

INTRODUCTION: Family planning (FP) is crucial for improving maternal and newborn health outcomes, promoting gender equality, and reducing poverty. Unmet FP needs persist globally, especially in South Asia and Sub-Saharan Africa leading to unintended pregnancies, unsafe abortions, and maternal fatalities. This study aims to identify the determinants of unmet needs for FP from a nationally representative survey.

METHODS: We analyzed the data of 11,180 currently married women from nationally representative Nepal Health Demographic Survey 2022. We conducted weighted analysis in R statistical software to account complex survey design and non-response rate. We conducted univariate and multivariable binary and multinomial logistic regression to assess association of unmet need for FP with independent variables including place of residence, province, ecological belt, ethnicity, religion, current age, participant’s and husband’s education, occupation, wealth quintile, parity, desire for child, and media exposure.

RESULTS: The total unmet FP need was 20.8% (95%CI: 19.7, 21.9) accounting 13.4% (95%CI: 12.5, 14.4) for unmet need for limiting and 7.4% (95%CI: 6.8, 8.0) for unmet for spacing. Lower odds of total unmet need for FP were present in 20-34 years and 35-49 years compared to <20 years, women belonging to Madhesi ethnic group (AOR: 0.78; 95%CI: 0.64, 0.95) compared to Brahmin/Chhetri, women from richest (AOR: 0.69; 95%CI: 0.56, 0.84), richer (AOR: 0.82; 95%CI: 0.68, 0.97) and middle wealth quintile (AOR: 0.82; 95%CI:0.70, 0.98) groups compared poorest wealth quintile group and women belonging to rural area (AOR: 0.89; 95%CI: 0.80, 0.99) compared to urban area. Higher odds of unmet need for FP were present among women with basic (AOR: 1.34; 95%CI: 1.17, 1.54), and secondary level (AOR: 1.32; 95%CI: 1.12, 1.56) education compared to women without education, among women from Madhesh (AOR: 1.56; 95%CI: 1.22, 1.98), Gandaki (AOR: 2.11; 95%CI: 1.66, 2.68), Lumbini (AOR: 1.97; 95%CI: 1.61, 2.42) and Sudurpashchim province (AOR: 1.64; 95%CI: 1.27, 2.10) compared to Koshi province and among women whose husband education was basic level (AOR:1.37; 95%CI: 1.15, 1.63), or secondary level (AOR: 1.32; 95%CI: 1.09, 1.60) education.

CONCLUSION: Nepal faces relatively high unmet FP needs across various socio-demographic strata. Addressing these needs requires targeted interventions focusing on age, ethnicity, religion, education, and socio-economic factors to ensure universal access to FP services.

PMID:38820547 | DOI:10.1371/journal.pone.0303634

PLOS Glob Public Health. 2024 May 31;4(5):e0003258. doi: 10.1371/journal.pgph.0003258. eCollection 2024.

ABSTRACT

Combination HIV prevention packages have reduced HIV incidence and improved HIV-related outcomes among young people. However, there is limited data on how package components interact to promote HIV-related prevention behaviours. We described the uptake of HIV prevention interventions supported by Determined, Resilient, Empowered, AIDS-free, Motivated and Safe (DREAMS) Partnership and assessed the association between uptake and HIV-related behaviours among young people in rural KwaZulu-Natal, South Africa. We analysed two cohorts followed from May 2017 to December 2019 to evaluate the impact of DREAMS, covering 13-29 year-old females, and 13-35 year-old males. DREAMS interventions were categorised as healthcare-based or social. We described the uptake of interventions and ran logistic regression models to investigate the association between intervention uptake and subsequent protective HIV-related outcomes including no condomless sex and voluntary medical male circumcision (VMMC). For each outcome, we adjusted for socio-demographics and sexual/pregnancy history and reported adjusted odds ratios (aOR) and 95% confidence intervals (CI). Among 5248 participants, uptake of healthcare interventions increased from 2018 to 2019 by 8.1% and 3.7% for males and females respectively; about half of participants reported receiving both healthcare and social interventions each year. The most utilised combinations of interventions included HIV testing and counselling, school-based HIV education and cash transfers. Participation in social interventions only compared to no intervention was associated with reduced condomless sex (aOR = 1.60, 95%CI: 1.03-2.47), while participation in healthcare interventions only was associated with increased condomless sex. The uptake of interventions did not significantly affect subsequent VMMC overall. Among adolescent boys, exposure to school-based HIV education, cash transfers and HIV testing and counselling was associated with increase in VMMC (aOR = 1.79, 95%CI: 1.04-3.07). Multi-level HIV prevention interventions were associated with an increase in protective HIV-related behaviours emphasizing the importance of accessible programs within both school and community settings for young people.

PMID:38820546 | DOI:10.1371/journal.pgph.0003258

PLoS One. 2024 May 31;19(5):e0303993. doi: 10.1371/journal.pone.0303993. eCollection 2024.

ABSTRACT

This study investigates how the landscape of sex work in Dar es Salaam, Tanzania, evolved in the context of the COVID-19 epidemic. Using a mixed-methods approach, the analysis triangulates data from quantitative and qualitative sources to quantify shifts in income, demand, and client frequency and describe female sex workers’ perspectives on their work environment. The COVID-19 restrictions introduced in early 2020 resulted in dramatic decreases in sex work income, leading to extreme financial vulnerability, food insecurity, and challenges in meeting other basic needs such as paying rent. However, in a 2021 follow-up survey, sex workers reported the summer of 2021 as a key turning point, with the demand for sex work rebounding to closer to pre-pandemic levels. Notably, despite the average number of unique weekly clients not yet having fully rebounded, by 2021 the price per client and the total monthly sex work income had returned to pre-pandemic levels. This may potentially be explained by an increased number of repeat clients, which represented a larger proportion of all clients during the COVID-19 pandemic.

PMID:38820534 | DOI:10.1371/journal.pone.0303993

PLoS One. 2024 May 31;19(5):e0300454. doi: 10.1371/journal.pone.0300454. eCollection 2024.

ABSTRACT

PURPOSE: We aimed to determine (1) the most commonly used brands of electronic vaping products (EVPs) by young adults in Texas during Spring 2023, and (2) if brand preferences differ by sociodemographic characteristics, current cigarette smoking, and current cannabis vaping.

METHOD: Participants were 2,491 18-25-year-olds (Mean age = 20.6; 62.9% female; 29.7% sexual gender minority; 35.9% non-Hispanic White, 45.0% Hispanic/Latino, 3.5% non-Hispanic Black, 11.6% non-Hispanic Asian, and 4.0% two or more races or another race/ethnicity) enrolled in 21 Texas colleges during February-March 2023 who used EVPs in the past 30-days.

RESULTS: Esco Bar was the most popular EVP brand (32.5%), followed by Elf Bar (19%), Vuse (10.1%), and all other brands were used by < 10% of participants. Nearly 20% of participants reported not having a usual brand. Participants who used Esco Bar, Elf Bar, and Puff Bar were younger (i.e., 18-20 years old), female, and Hispanic/Latino. Vuse, JUUL, and Smok were used by participants who were older (i.e., 21-25 years old), male, non-Hispanic white, used EVPs daily, and currently smoked cigarettes.

CONCLUSION: The present study extends prior research by providing contemporary data on young adult EVP brand preferences in Texas during Spring 2023. Many of the brands commonly used by young adults (e.g., Esco Bar, Elf Bar) are not currently authorized for marketing or sale by the Food and Drug Administration. Findings underscore a need for additional enforcement efforts that prohibit the distribution and sale of these products to, in turn, prevent EVP use among young adults.

PMID:38820522 | DOI:10.1371/journal.pone.0300454

PLoS One. 2024 May 31;19(5):e0301684. doi: 10.1371/journal.pone.0301684. eCollection 2024.

ABSTRACT

BACKGROUND: Childhood and adolescent obesity are major, preventable public health concerns. Studies to date are inconclusive regarding an association between caesarean section (CS) delivery and offspring obesity, with fewer studies conducted in late adolescence. This study examined the association between CS delivery, with a specific focus on planned CS, and induction of labour and adolescent body mass index (BMI) and body fat percentage (BF%) at age 17 years.

METHODS: Data on 8,880 mother-child pairs from the United Kingdom Millennium Cohort Study were analysed. The exposures were mode of delivery (normal vaginal delivery (VD) (reference), assisted VD, planned CS and emergency CS) and mode of delivery by induction of labour status. Crude and adjusted binary logistic regression and linear regression models were fitted examining BMI and BF% at age 17 years respectively, adjusting for several potential confounders.

RESULTS: Adolescents born by CS did not have an elevated BMI or BF% compared to those born by normal VD. The fully adjusted results for overweight and obesity in children born by planned CS, compared to VD, were 1.05 (95% CI: 0.86-1.28) and 0.94 (95% CI: 0.72-1.23), respectively. The results were similar for the associations between CS and BF%, and between induction of labour and BMI.

CONCLUSION: Overall, this large longitudinal study did not support an association between CS or induction of labour and overweight, obesity or BF%. It is possible that previously reported associations are due to residual or unmeasured confounding and/or underlying indications for CS delivery.

PMID:38820521 | DOI:10.1371/journal.pone.0301684

PLoS One. 2024 May 31;19(5):e0295648. doi: 10.1371/journal.pone.0295648. eCollection 2024.

ABSTRACT

BACKGROUND: Gender disparity is pervasive in academic medicine. This study aimed to assess the disparity between men and women with regard to first and senior author positions in primary studies on liver cancer over the last two decades.

METHODS: We conducted a review of articles published in high-impact factor journals of the field of Gastroenterology and Hepatology in 2005, 2010, 2015 and 2020. First and senior authors of all ages were considered as the study population. The authors’ genders were determined using the online artificial intelligence tool genderize.io (https://genderize.io/). The disparity between men and women authors was assessed using the linear-by-linear association test.

RESULTS: 665 original articles from 10 journals were reviewed. The point prevalence of first women authors was 25.0% compared with 75.0% for men. The point prevalence of senior women authors was 16.3% compared with 83.7% for men. From 2000 to 2020, the proportion of first women authors increased 14.4% to 26.8% compared with 85.6%-73.2% for men (P = 0.009), and the proportion of senior women authors increased from 7.4% to 19.5%, compared with 92.6%-80.5% for men (P = 0.035). The factor independently associated with a reduced representation of women among first authors was the region of author. The factor independently associated with a reduced representation of women among senior authors was the impact factor of journals.

CONCLUSION: The findings indicated a remarkable increase in the proportion of women, both first and senior authors, over the past two decades in the field of liver cancers. However, the representation of women authors in this area is far less than that of men.

PMID:38820519 | DOI:10.1371/journal.pone.0295648

PLoS One. 2024 May 31;19(5):e0299356. doi: 10.1371/journal.pone.0299356. eCollection 2024.

ABSTRACT

The government of Saudi Arabia is making significant efforts to improve the quality of health education and healthcare services. Professional identity has been linked to the quality of healthcare services provided by practitioners, however, data concerning the professional identity of health profession students (HPS) and healthcare practitioners (HCP) are still lacking in Saudi Arabia. The current study aimed to assess the level of professional identity in HPS and HCP in Saudi Arabia and to investigate its predictors. Cross-sectional data were collected from 185 HPS and 219 HCP in Saudi Arabia using river sampling technique. Data related to the sample characteristics were collected; an adapted version of the Macleod Clark Professional Identity Scale was utilized to collect data about the level of professional identity. Total score of professional identity was later calculated for each participant. Median professional identity scores for HPS and HCP were 38.0 (34.0-41.0) and 41.0 (37.0-43.0), respectively, out of 45. Significantly higher median professional identity score was found among HCP as compared to HPS (p <0.001). Data obtained from the multiple linear regression analysis, using the backward elimination method technique indicated that only working status (HPS vs. HCP) significantly predicted the professional identity score in all models performed. In conclusion, high levels of professional identity were reported among HCP and HPS in Saudi Arabia. Changes related to professional identity should be monitored in public and private educational and healthcare organizations to enhance the quality of healthcare services provided in the country.

PMID:38820518 | DOI:10.1371/journal.pone.0299356